PROVIDENCE SAINT JOHNS MEDICAL FOUNDATION 2121 SANTA MONICA BLVD SANTA MONICA, CA ZIP 90404 Phone: (310) 582-7312 Get Directions Mailing Address PROVIDENCE SAINT JOHNS MEDICAL FOUNDATION 2020 SANTA MONICA BLVD STE 300 SANTA MONICA, CA ZIP 90404 Phone: (310) 582-7312 Location Map Authorized Official Tab will move on to the next part of the site rather than go through menu items. Mon., Dec. 25: 9 a.m. - 1:00 p.m. Wed., Nov. 27 - 8 a.m.- 5 p.m. Note: Due to high volume, please call before departure to verify our hours If you receive APTC, you are also eligible for an extended grace period (see Grace Period). Virtual Appointment | Email Us | Map It 1201 W. La Veta Ave. An inside look at how youre helping us save lives. Enter and space open menus and escape closes them as well. Messages should not contain personal health information. Martin Luther King Jr. Day - Monday, January 16 After receiving the additional information, Providence will complete its review and notify you and your Provider or just you of its decision within two business days. Chino Hills, CA 91709. Deductibles, Copayments or Coinsurance for a Covered Service if indicated in any Benefit Summary as not applicable to the Out-of-Pocket Maximum. This organization is required to file an IRS Form 990 or 990-EZ. 400 North McDowell Blvd., Petaluma, CA 94954 (707) 525-5300. Memorial Day - Monday, May 29 T: (657) 500-0229 Christmas Eve / Christmas Day Mission Viejo, CA 92691 If an ongoing course of treatment for you has been approved by Providence and it then determines through its medical cost management procedures to reduce or terminate that course of treatment, you will be provided with advance notice of that decision. (442) 936-3626, St. Joseph Hospital, Orange Expedited coverage determinations will be made if waiting the standard timeframe will cause serious harm to your health. St. Vincent Medical Foundation Willamette Falls Medical Foundation . Email:Christina Crawford. THESE EFFORTS SEEK TO MITIGATE IMMEDIATE CHALLENGES WHILE FINDING SOLUTIONS TO DEEP-ROOTED PROBLEMS, IMPROVE ACCESS TO HEALTH CARE, AND ADVANCE INNOVATIVE CARE MODELS TO MEET THE EVOLVING NEEDS OF OUR COMMUNITIES.CARING FOR OUR COMMUNITIES HAS NEVER BEEN MORE IMPORTANT. If Providence finds a problem with a Claim (such as a duplicate or improperly coded Claim) after the Claim has been paid, Providence can retroactively deny the Claim to fix the problem. All Rights Reserved. For example, we might talk to your Provider to suggest a disease management program that may improve your health. IN 2020, WE INVESTED $1.7 BILLION IN COMMUNITY BENEFIT ACROSS SEVEN REGIONS, TO SUPPORT ORGANIZATIONS, PROGRAMS AND INITIATIVES THAT CREATE LASTING CHANGE AT THE COMMUNITY LEVEL. Explore our directory for contact information for our Centers of Excellence, surgeons, doctors and caregivers. Memorial Day - Monday, May 29 Sun., Dec. 24: 9 a.m. - 6 p.m. When purchasing a Prescription Drug, you may have to pay Coinsurance or make a Copayment. Memorial Day - Monday, June 29 The following Out-of-Pocket costs do not apply toward your Out-of-Pocket Maximum: A claim that requires further information or Premium payment before it can be fully processed and paid to the health care Provider. New Year's Eve/Day Sun: 9 a.m. - 2 p.m. (Last walk-in patient at 1:30 p.m.), 1621 W. Imola Ave., Please note hours and availability of our urgent cares may be impacted. Closed on Saturday and Sunday. Let us help you find the plan that best fits you or your family's needs. Providence Saint John's Health Center 2121 Santa Monica Blvd, Santa Monica, CA 90404 2253.1 miles away 310-829-5511 Overview Classes and Events Ways to Give For over 75 years, Saint John's Health Center has provided the Los Angeles community an amazing array of medical specialties and sub-specialties. If you choose a brand-name drug when a generic-equivalent is available, any difference in cost for Prescription Drug Covered Services will not apply to your Calendar Year Deductibles and Out-of-Pocket Maximums. Mail your claim and supporting document(s) to the address below: Alternatively, you may send the information by fax to, Have your knowledge and agreement while receiving the Service, Be prescribed and approved by your Provider; and. If you do not pay the Premium within 10 days after the due date, we will mail you a Notice of Delinquency. Whether you're a new or existing patient, Ranked in the top neurology and neurosurgery programs in the nation by US News & World Report, Pacific Neuroscience Institute specialists provide comprehensive care for a wide spectrum of neurological disorders at Providence . Thanksgiving The information contained in this website is only for general information purposes. You do not need Prior Authorization for emergency treatment; however, we must be notified within 48 hours following the onset of inpatient hospital admission or as soon as reasonably possible. To qualify for expedited review, the request must be based upon urgent circumstances. Victorville, CA 92395. You can find the Prescription Drug Formulary here. Labor Day - Monday, September 4 You go to a hospital emergency room to have stitches removed, rather than wait for an appointment in your doctors office. Participating Pharmacies may not charge you more than your Copayment of Coinsurance, except when Deductible and/or coverage limitations apply. Thurs., Nov. 23: 8 a.m. - 12:00 p.m. Information about Recurring Gifts. The agreement between you and Providence that defines the obligations of both parties to maintain health insurance coverage. (714) 771-8000, St. Jude Medical Center Sun., Dec. 31: 9 a.m. - 6 p.m. Christmas Eve / Christmas Day Apple Valley, CA 92307, Your Plan only pays for Covered Services received from approved, Prior Authorized Out-of-Network Providers at rates allowed under your plan. /PRNewswire/ -- Providence Health & Services announced today a new affiliation with Pacific Neuroscience Institute, a multispecialty group of more than 30. time as your physician, renew prescriptions and pay your bills. IN SERVICE TO OUR MISSION, PROVIDENCE PARTNERS WITH COMMUNITY-BASED ORGANIZATIONS TO IDENTIFY URGENT HEALTH NEEDS AND ENVIRONMENTAL FACTORS THAT ARE IMPACTING THE WELL-BEING OF OUR COMMUNITIES. An EOB explains how Providence processed your Claim, and will assist you in paying the appropriate member responsibility to your Provider. SANTA MONICA (Feb. 2, 2023) - Living the Providence tradition of outreach to the under-served, Providence Saint John's Health Center and the Saint John's Health Center Foundation recently provided grants totaling more than $2 million to 33 programs across the Westside. Holiday Hours: New Year's Eve/Day T: This information will only be used to contact you regarding your message. During the first month of the grace period, your prescription drug claims will be covered according to your prescription drug benefits. Providence Health Plan offers commercial group, individual health coverage and ASO services.Providence Health Assurance is an HMO, HMOPOS and HMO SNP with Medicare and Oregon Health Plan contracts. 4th of July - Tuesday, July 4 Mon., Dec. 25: 8 a.m. - 12:00 p.m. 26800 Crown Valley Pkwy., Suite 280 Open daily from 8 a.m. to 8 p.m. Labor Day - Monday, September 4 Claims involving concurrent care decisions. If Providence needs additional information to complete its review, it will notify the requesting provider or you within 24 hours after the request is received. You or the out-of-network provider must call us at 800-638-0449 to obtain prior authorization. Download hospital map & directions. Providence will then notify you of its reconsideration decision within 24 hours after your request is received. (800) 309-9729, Hoag Hospital Irvine Sun: 9 a.m. - 5 p.m. For services that involve urgent medical conditions: Providence will notify your provider or you of its decision within 72 hours after the prior authorization request is received. 4th of July - Tuesday, July 4 In addition to its medical groups, Heritage supports six distinct affiliated physician networks throughout the state. Mon., Dec. 25: 8 a.m. - 12 p.m. Prior authorization for services that involve urgent medical conditions. Services or supplies your medical care Provider needs to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine. Labor Day - Monday, September 4 If timely repayment is not made, we have the right, in addition to any other lawful means of recovery, to deduct the value of the excess benefit from any future benefit that otherwise would have been available to the affected Member(s) from us under any Contract. to get more GuideStar Nonprofit Profile data today! Learn More Provider Resources Electronic claims About ProvLink Medical policies & forms Member forms Prior authorization request form (PDF) Electronic Direct Deposit Go direct. Laguna Niguel, CA 92677. (800) 309-9729. Orange, CA 92868 Our medical directors and special committees of Network Providers determine which services are Medically Necessary. Santa Monica, CA 90404 . Napa, CA 94558 (657) 933-5726, St. Jude Heritage Medical Group - Santa Ana Use of this website constitutes acceptance of the Terms of Service and Privacy Policy. 2141 Harbor Blvd., Suite 18000 New Year's Eve/Day Laguna Niguel, CA 92677. Let us help you find the plan that best fits your needs. Note: Due to high volume, please call before departure to verify our hours Multiple locations Clinical trials give patients access to leading-edge treatments and procedureswhile facilitating research discoveries. Mon., Dec. 25: 8 a.m. - 12:00 p.m. Conveniently located in the Saint John's Medical Plaza Building in Santa Monica California. You may present your case in writing. Compassion, Dignity, Justice, Excellence, Integrity. You can submit your appeal one of three ways: If you would like to submit a verbal complaint or have questions about the grievance and appeal process, contact a Customer Service representative at 503-574-7500 or 800-878-4445. Customer Service Assistance : (800) 627-8106 Patient Billing Assistance : (855) 221-8046 Self Help: High Desert | Northern California | Orange County | South Orange County Email: sjhmghelp@stjoesupport.zendesk.com Services provided by out-of-network providers. For standard requests, Providence Health Plan will notify your provider or you of its decision within 72 hours after receipt of the request. Santa Ana, CA 92705, Durable medical equipment, including but not limited to: Certain infused prescription drugs administered in a hospital-based infusion center, Member ID number and plan number (refer to your member ID card), Provider name, address and telephone number, Date of admission or date services are to begin, Mail it to: Providence Health Plan, Appeals and Grievances Department, PO Box 4158, Portland, Oregon 97208-4158. Were here to give you the support and resources you need. Providence will only pay for Medically Necessary Covered Services. WE ACT TO PROVIDE SHORT-TERM SOLUTIONS AND ENVISION LONG-TERM RESULTS BY WISELY INVESTING IN OUR COMMUNITIES TO HELP BUILD A MORE EQUITABLE AND SUSTAINABLE FUTURE. If we need additional information to complete the processing of your Claim, the notice of delay will state the additional information needed, and you (or your provider) will have 45 days to submit the additional information. Contact Us. PROVIDENCE SAINT JOHNS MEDICAL FOUNDATION | 17 followers on LinkedIn. Phone 310-829-8424. 1140 W. La Veta Ave. (707) 445-8121, St. Joseph Hospital, Eureka Providence Saint Johns Medical Foundation is a Charitable Organization headquartered in Renton, WA. We believe that the health of a community rests in the hearts, hands, and minds of its people. If the cost of your Prescription Drug is less than your Copayment, you will only be charged the cost of the Prescription Drug. Saint Johns has a well-earned reputation for clinical excellence and award-winning care in a compassionate and tranquil healing environment. 4th of July - Tuesday, July 4 Please see your Benefit Summary for information about these Services. SANTA MONICA, Calif., Oct. 6, 2022 /PRNewswire/ -- Providence Saint John's Health Center has . We reserve the right to make substitutions for Covered Services; these substituted Services must: * If you fail to obtain a Prior Authorization when it is required, any claims for the services that require Prior Authorization may be denied. Expedited determinations will be made within 24 hours of receipt. Within two business days of the receipt of the additional information, Providence will complete its review and notify you and your Provider of its decision. Usually, Providers file claims with us on your behalf. Providence Saint Johns Medical Foundation, Allopathic & Osteopathic Physicians/Otolaryngology, Allopathic & Osteopathic Physicians/Internal Medicine, Allopathic & Osteopathic Physicians/Obstetrics & Gynecology, Allopathic & Osteopathic Physicians/Family Medicine, Student, Health Care/Student in an Organized Health Care Education/Training Program, Physician Assistants & Advanced Practice Nursing Providers/Physician Assistant, Internal Medicine/Hospice and Palliative Medicine, Physician Assistants & Advanced Practice Nursing Providers/Nurse Practitioner, Registered Nurse/Registered Nurse First Assistant, Allopathic & Osteopathic Physicians/Orthopaedic Surgery, Nursing Service Providers/Registered Nurse, Allopathic & Osteopathic Physicians/Hospitalist, Family Medicine/Hospice and Palliative Medicine, Speech, Language and Hearing Service Providers/Speech-Language Pathologist, Internal Medicine/Interventional Cardiology, Respiratory, Developmental, Rehabilitative and Restorative Service Providers/Physical Therapist, Allopathic & Osteopathic Physicians/Emergency Medicine, Dietary & Nutritional Service Providers/Dietitian, Registered, Allopathic & Osteopathic Physicians/Ophthalmology, Allopathic & Osteopathic Physicians/Surgery, Psychiatry & Neurology/Vascular Neurology, Allopathic & Osteopathic Physicians/Urology, Allopathic & Osteopathic Physicians/General Practice, Allopathic & Osteopathic Physicians/Neurological Surgery, Allopathic & Osteopathic Physicians/Thoracic Surgery (Cardiothoracic Vascular Surgery), Speech, Language and Hearing Service Providers/Audiologist, Speech, Language and Hearing Service Providers/Audiologist-Hearing Aid Fitter, Obstetrics & Gynecology/Female Pelvic Medicine and Reconstructive Surgery, Allopathic & Osteopathic Physicians/Pediatrics, Internal Medicine/Advanced Heart Failure and Transplant Cardiology, Behavioral Health & Social Service Providers/Clinical Neuropsychologist, Psychologist/Mental Retardation & Developmental Disabilities, Behavioral Health & Social Service Providers/Psychologist, Internal Medicine/Endocrinology, Diabetes & Metabolism, Internal Medicine/Clinical Cardiac Electrophysiology, Psychiatry & Neurology/Psychosomatic Medicine, Emergency Medical Service Providers/Personal Emergency Response Attendant, Psychiatry & Neurology/Clinical Neurophysiology, Psychiatry & Neurology/Neuromuscular Medicine, Santa Monica Gynecological And Obstectrical Medical Group Incorporated, University Foot And Ankle Institute A Podiatric Surgical Center, The Regents Of The University Of California, Santa Monica Therapy A Psychology Corporation, Silver Od Pc And Taketa Od Pc A Partnership Of Opt Corp. (Please note last patient check in is at 7:30 p.m.) Browse value-added services & buy-up options, Prescription Drug reimbursement request form, General Medical Prior Authorization Fax Form, Carelon Medical Benefits Management (formerly AIM Specialty Health). A request to us by you or a Provider regarding a proposed Service, for which our prior approval is required. Build relationships with key people who manage and lead nonprofit organizations with GuideStar Pro. Providence Saint Johns Health Center T: On rare occasions, such as urgent or emergency situations, you may need to use an Out-of-Network Pharmacy. 2251 N. Harbor Blvd., Please see Appeal and External Review Rights. Santa Rosa, CA 95405, , 1162 Montgomery Dr., 2nd Floor after hours, we'll get back to you as soon as possible. Retail: A Network Pharmacy that allows up to a 30-day supply of short-term and maintenance prescriptions. Mon., Jan 17 - CLOSED. Laguna Beach, CA 92651 Consult your member materials for details regarding your out-of-network benefits. If any information listed below conflicts with your Contract, your Contract is the governing document. Christmas Eve / Christmas Day You can find Providence Health Plans nationwide pharmacy network using our pharmacy directory. We allow 15 calendar days for you or your Provider to submit the additional information. Give your employees health care that cares for their mind, body, and spirit. If you do not pay all amounts of premium by the date specified in the notice of delinquency, you will be responsible for the Claims for any services received during the second and third months. Providence Saint John's Health Center 2121 Santa Monica Blvd. Mission Viejo, CA 92691 We may not pay for the extra day. You must file your appeal with Providence Health Plan in writing and within 180 days of the date on the Explanation of Benefits, or that decision will become final. Sun., Dec. 31: 9 a.m. - 6 p.m. Please note hours and availability of our urgent cares may be impacted. TO ACHIEVE OUR VISION OF HEALTH FOR A BETTER WORLD, OUR PROVIDENCE FAMILY OF ORGANIZATIONS FOCUSED ON FOUR COMMUNITY INITIATIVES IN 2020:1 FOUNDATIONS OF HEALTH;2 REMOVING BARRIERS TO CARE;3 COMMUNITY RESILIENCE; AND4 INNOVATING FOR THE FUTURE.WE CHOSE THESE FOCUS AREAS BECAUSE THEY ARE ALL FOUNDATIONAL TO HEALTH AND WELL-BEING, REPRESENTING IDENTIFIED NEEDS THAT ARE INTEGRAL TO IMPROVING QUALITY OF LIFE.PROGRAM SERVICE ACCOMPLISHMENTSPROVIDENCE SAINT JOHN'S MEDICAL FOUNDATION D.B.A. Services that involve prescription drug formulary exceptions. If you pay your Premiums in full before the date specified in the notice of delinquency, your coverage will remain in force and Providence will pay all eligible Pended Claims according to the terms of your coverage. If you fail to obtain a Prior Authorization when it is required, any claims for the services that require Prior Authorization may be denied. Certain Covered Services, such as most preventive care, are covered without a Deductible. Provided to you while you are a Member and eligible for the Service under your Contract. New Year's Eve/Day Napa, CA 94558 T: Is this your nonprofit? Payment will be made to the Policyholder or, if deceased, to the Policyholders estate, unless payment to other parties is authorized in writing. to its medical groups, Heritage supports six distinct affiliated physician If you are hearing impaired and use a Teletype (TTY) Device, please call our TTY line at 711. To facilitate our review of the Prior Authorization request, we may require additional information about the Members condition and/or the Service requested. We reserve the right to deny payment for Services that are not Medically Necessary in accordance with our criteria. If your formulary exception request is denied, you have the right to appeal internally or externally. We reserve the right to suspend Claims processing for members who have not paid their Premiums. Try a low commitment monthly plan today. Fortuna, CA 95540 1000 Trancas St. wherever you are. 4th of July - Tuesday, July 4 Thanksgiving Also, if you are insured by more than one insurance company, there may be a dispute between Providence and the other insurance company which can also lead to a retroactive denial of your Claim (see Coordination of Benefits). . in clinical quality. Open Daily, 8 a.m. - 8 p.m. Holiday Hours: 8 a.m. - 5 pm. Your Coinsurance for a Covered Service is shown in the Benefit Summary, and is a percentage of the charges for the Covered Service. (714) 871-3280, CHOC Childrens Providence Saint Johns Medical Foundation is a Medical Group that has 60 practice medical offices located in 1 state 12 cities in the USA. Sun: 9 a.m. - 5 p.m. Multiple Locations Mon., Dec. 25: 8 a.m. - 12 p.m. Closed: Martin Luther King Jr. Day, Easter, Memorial Day, Independence Day, Labor in 1994 and includes eight medical groups throughout California. Sun., Dec. 24: 9 a.m. - 6 p.m. Enrollment in Providence Health Assurance depends on contract renewal. Up and Down arrows will open main level menus and toggle through sub tier links. Petaluma, CA 94954 (707) 778-1111, Queen of Valley Medical Center T: 707) 740-4418, Queen of Valley Medical Center Memorial Day - Monday, June 29 Contact us. Windsor, CA 95492. If you want more information on how to obtain prior authorization, please call Customer Service at 800-638-0449. Your coverage will end as of the last day of the first month of the three month grace period. The requesting provider or you will then have 48 hours to submit the additional information. The person whom this Contract has been issued. Saturday, Sept. 5: 9 a.m. - 5 p.m. The Plan does not have a contract with all providers or facilities. (Last patient accepted at 7:30 p.m.) See your Contract for details and exceptions. Shield Concierge: Phone: (855) 599-2657 . Memorial Day - Monday, June 29 Thanksgiving Note: Due to high volume, please call before departure to verify our hours 27700 Medical Center Rd. Typically, Providence individual plans do not pay for Services performed by Out-of-Network Providers. Providence is a national, nonprofit Catholic health system comprising a diverse family of organizations and driven by a belief that health is a human right. Ca 92651 Consult your member materials for details and exceptions details and exceptions Laguna Beach CA! Your behalf member responsibility to your Provider to suggest a disease management that. 400 North McDowell Blvd., Suite 18000 New Year 's Eve/Day Laguna Niguel CA! 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